Choices

Sermon Delivered by

Bryant Brown

27 January 2008 

It is a topic on the lips and on the minds and in the hearts of politicians who take their stand – principled or opportunistic – on the Pro-life-Pro-choice divide. So, we hear a lot about that. But there is certainly more. Think of all the joys and concerns we share here every week – how many of them are around our health care.

It is not just pro-life-pro-choice, and it is not just legislators and presidents who have a say and want to have a say in our health-care decisions – doctors, hospital administrators, judges, televangelists, insurance companies, and pharmacists all have a voice, it seems. And, of course, there are the people with signs, and with ads and with whole broadcast networks who want to influence our choices, and the choices made for us by politicians and medical people and all those others.

It is complicated. It is divisive. And it is very personal. Or should be.

As poet and Unitarian Universalist minister, Ric Masten, points out, if you want to know what a UU believes, you have to ask her or him. Where we stand together as a denomination on reproductive health choices is shown in resolutions passed in our annual, national General Assemblies. Over the past forty-plus years G-A delegates have voted for eleven resolutions supporting a woman’s right to choose.

In the interest of full disclosure, I point out that the cloth on the pulpit is actually a t-shirt. I wore it to the March for Women’s Lives in April of 2004. Maggie and I joined many hundreds of Unitarian Universalists and a million or so of our closest friends in Washington DC showing support for showing trust in women’s choices. If you ask this UU what he believes, that’s what I’ll tell you – with my words with my actions.

A couple of weeks ago, Stephanie Barnett told us about part of our heritage: about the Unitarian King John Sigismund of Transylvania and about Francis David. You remember she told you how David died in prison in 1579 for the crime of religious innovation. He was not the first nor last.

When I am reading our Unitarian and Universalist history, and realize the bravery of people in our tradition, and when I am looking for a modern, American example of how religious doctrines can so enrage and so incite and so divide humans that we persecute, prosecute, and execute our fellow human beings, I need look no farther than the rage over pro-life-pro-choice.

The ethical, moral, religious convictions around health care, especially reproductive health care, especially for women, lead to fanatical, violent, deadly actions.

Those in this congregation who participate in a march for women’s lives or who escort patients into Women’s Centers can tell you about the angry voices, the raised fists, the red faces of pro-life demonstrators. Clinics have been bombed. A few years ago a retired Unitarian Universalist minister was shot-gunned to death in Florida while serving as an escort at a women’s pregnancy and abortion clinic. More recently, a UU was shot in Massachusetts while working at a Planned Parenthood clinic. The summer before last, a member of a UU church in Mississippi was knocked down by a car driven by an anti-abortion protester who was part of a demonstration against the congregation’s position. The pro-choice demonstrators beat on the car, breaking the windshield. Violent actions happen on both sides. Thankfully, no one was hurt that time.[1]

It is both sides…. One book I’ve read on the abortion issue says that it – the book – “uncovers the dubious alliance between (on the one hand) a nearly universally suspect moral position and the groups and individuals who promote it and (on the other) the communities and organizations of truth-seekers who have wrestled with it and have even agonized over it.”[2]

It seems to me that people on each side of the dispute – it is certainly more than a debate – people on each side could see the other side as holding a “suspect moral position” and themselves as “communities and organizations of truth-seekers.” Both sides are sure of their position, based on moral precepts, and suspect the other side’s morality. As a matter of fact, the quote is from a book published for the National Pro-life Religious Council.

The actions – the working and the escorting, the demonstrating, the publishing, the shouting and the shooting – are expressions of people’s beliefs – what is life and what makes it important. And laws and judicial decisions are based on beliefs. So are hospital policies. So are the actions of pharmacists. Sadly, these are apparently not matters where we can just “agree to disagree.” These are not matters where, even in a democratic society, compromise solutions are obvious or even sought.

Just a few days ago was the thirty-fifth anniversary of the U‑S Supreme Court’s Roe-versus-Wade decision that decriminalized abortion. There are many in this country – in this room – who have not lived when abortion was illegal – criminally punishable.

For reasons, I suppose, best understood by lawyers, Roe-v-Wade was argued and decided on the basis of privacy. These days, it seems the right of privacy is up for grabs. Phone conversations and e-mail messages are open to government agencies. Our electronic world leaves clear, accessible, trails for those who would follow our doings – there seem few protections for privacy in this country.

And we well know that the composition of the Supreme Court is remarkably different than it was 35 years ago. A decision about privacy in this climate, before this court, could result in a very different decision.

In fact, Roe-v-Wade is being whittled away. It is tenuous. It is not a law, it is not in the Constitution, it is a judicial ruling. Courts change their mind. For the first time in these 35 years, the high court has upheld a criminal ban of an abortion procedure.[3] So, now, the court is saying that, again, legislators’ preferences trump our choices about the practice of medicine on our bodies.

I have hovered over the issue of abortion and women’s health care because the topics seem so intractable – because they are based on differing perceptions of emotionally, rather than rationally understood, subjectively measurable principles. Where do our affirming and promoting of “the inherent worth and dignity of every person” and the “free and responsible search for truth and meaning” lead us in such issues? It is tough to talk about. In a democracy, it matters. Among members of a faith community, it matters. Among members of a faith community that forms a tiny minority in a democracy, it matters.

It is not just women’s health care that brings us to these disputes. Even where access to medical treatment is not an issue – remember, we are imagining it is not – we are not the only ones making choices about the care we, ourselves, receive.

A year ago, an article in The New England Journal of Medicine reported that 14 percent of the physicians they surveyed said they believe it is acceptable to not tell patients of medical options that they, the doctors, find morally objectionable. In fact, the study finds that

Many physicians do not consider themselves obligated to disclose information about or refer patients for legal but morally controversial medical procedures. [The study by the University of Chicago notes that] Patients who want information about, and access to such procedures may need to inquire proactively to determine whether their physicians would accommodate such requests.[4]

The burden is on us. We need to ask not only what other treatment options were considered for us, but we should somehow find out those disregarded on the grounds of the doctor’s religious convictions. And, even if asked directly, would someone so strongly motivated feel obligated to tell us about legal but, to them, morally controversial medical procedures? That’s our doctors.

More than twenty percent of us in this country receive health care in facilities connected with religious organizations. The facilities have religiously based restrictions on the services offered, regardless of the patients’ religious, moral, ethical standards. Even where church-sponsored institutions merge with public, secular health organizations, it is usual that the religious body’s rules and restrictions remain in place.

People express their faith through opening and operating church-affiliated hospitals, clinics, out-patient facilities, universities, health management organizations, social service agencies, urgent-care centers, hospices, and nursing homes. It is certainly to be praised that these institutions exist. But the beliefs of the sponsoring religious organization can affect the care offered or denied. Many of these institutions receive public funding, from a public with a variety of sometimes-opposing and less-restrictive religious, moral, and ethical standards.

The “controversial” elements mentioned in the University of Chicago study can include such decisions as what treatments and procedures to perform or withhold at end of life.

This morning we sang together “Just as long as I have breath, I must answer ‘Yes’ to life.”[5] It can be a troubling hymn. What does that “Yes” look like? Is it a “Yes” to machines keeping my chest rising and falling and my heart pumping? For how long? In what circumstances? Is it the breath that my nerves and my muscles can organize to keep a life going that I really want to say “Yes” to? One that I put value to and find meaning in? That should be my decision, shouldn’t it?

Even if I am not the king in this morning’s story, if I want butter for my health-care bread, should someone else be able to give me marmalade instead?[6]

We may have properly completed and notarized living wills and durable medical power-of-attorney documents – and I certainly urge us all to have them.

I urge us all to be informed and to make those medical decisions, define that “Yes,” for ourselves when we are able to. And, please, to have the conversations with those we love and who care about us. And to decide and to document what medical treatment we want and who is to speak for us if we are not able to make our wishes known. Get that paperwork done and keep it where it can be found.

But know that those documents may be given to our health care providers and institutions, that our representatives may be present and know and voice our preferences, and that our wishes may still be ignored.

Sometimes it is a matter of politicians’ decision for us – laws passed – on what is required or prohibited. Often – very often – alarmingly often – choices of treatment are dictated by for-profit insurance companies’ rule makers. It can be the medical institutions’ administrators or religious sponsor’s regulations. Sometimes, as we’ve said, it is the individual doctor’s choice.

Even pharmacists exercise choices for us, determining what prescribed medicines they believe they are ethically, morally, religiously allowed to give to us, or are prohibited from dispensing.[7]

We, among most other people of faith in this country, hold individuals’ decisions for their lives, based on their understanding of ethics, morals, religion, to be paramount.

Our medical system, we are given to believe, respects the sovereignty of each patient and bases care on the objective, scientifically supported judgment of competent medical professionals and on the patient’s informed consent. But, as we see, there are many other players, acting on religious and profit motives. Much of it is behind the scenes, built into the system, or on matters not mentioned or even consciously thought about. It is hard to know who is making our health care choices for us. We need to know.

The anniversary of Roe-v-Wade got me thinking about the broader issue of choice in health care in a democracy. It is one example of how we, together, view individuals’ decision-making. How much do we trust ourselves?

That a judicial decision like Roe-v-Wade has been the background of how this country has operated for 35 years tells something about us. The dangerous situation we allowed to exist for women until 1973 tells something about us. That Roe-v-Wade is under attack, successfully, also tells about how we are as a people. That one political party’s candidates for president of the United States are, to a man and to a woman, pro-choice, and another party’s platform is pro-life shows the divide in how we see ourselves, and the individual and communal importance of taking part in the choice of our leaders.

At the visioning potluck a couple of weeks ago, people at the table where I sat noted that this faith is very much about choices – choices we make deliberately. We noted that few of us were born into Unitarian Universalism. We have sought out this faith and this church and these people around us and chosen to be here. We are a people wanting and willing to make decisions about our lives.

We want to, and do make decisions about how life is lived – about the value and the values we assign to life.

Our choices about the people we elect to make and enforce laws and the people they appoint to judicial and regulatory bodies impact the choices we, all of us, are allowed to make for ourselves.

In Pennsylvania, as in the majority of states, we elect our judges. So, without federal law or judicial decision, people even more subject to political pressures than U-S Supreme Court justices could also be among those making decisions for us about medical care. More of our involvement is called for.

One of our UU principles talks of interdependence. Our choices are not just our own. In a democratic society, in a society where many beliefs should be recognized and respected, it is important that, in the most inclusive way possible, especially in subjective matters – in ethical, moral, religious matters – that each individual's conscience be allowed to guide her or his own choices, but not control or restrict the exercise of conscience of others.

As Philip Simmons[8] points out in the readings, the nature of human life brings us to the religious questions: What is a good life? What is my right relationship to the universe? To others? To myself and my mortal body? Is there meaning?

We try on answers and make decisions about life and our place in it and among it. They should be our decisions to make.

So be it. Amen. 

©2008, Bryant Bossler Brown